Provider Demographics
NPI:1063285245
Name:KEELEN, CHEZZADI (PROF COUNSELOR)
Entity type:Individual
Prefix:
First Name:CHEZZADI
Middle Name:
Last Name:KEELEN
Suffix:
Gender:F
Credentials:PROF COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11306 HARBOUR LAKE CT
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77396-6010
Mailing Address - Country:US
Mailing Address - Phone:832-233-3086
Mailing Address - Fax:
Practice Address - Street 1:11306 HARBOUR LAKE CT
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-6010
Practice Address - Country:US
Practice Address - Phone:832-233-3086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88114101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional